Provider Demographics
NPI:1053616060
Name:KERTES, MARY A (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:KERTES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11716 PARKE COUNTY CIR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6757
Mailing Address - Country:US
Mailing Address - Phone:574-274-3640
Mailing Address - Fax:219-707-8123
Practice Address - Street 1:11716 PARKE COUNTY CIR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6757
Practice Address - Country:US
Practice Address - Phone:574-274-3640
Practice Address - Fax:219-707-8123
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017237A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist